Advances in Psychiatric TreatmentAspects (2004), of morbidvol. 10, jealousy207–215

Aspects of morbid Michael Kingham & Harvey Gordon

Abstract Morbid jealousy is encountered in general, old age and forensic psychiatry, and clinicians in each specialty should be familiar with its recognition and management. As well as clinical matters, the issue of risk to the patient and others is prominent in the consideration of morbid jealousy. Hospitalisation is sometimes required, the use of compulsory admission is not infrequent and treatment in secure settings is occasionally warranted. This review addresses the nature of morbid jealousy, its psychopathology, diagnostic issues, associations, risks and management.

Jealousy is a common, complex, ‘normal’ emotion. In popular usage, morbid jealousy has been The Oxford English Dictionary defines the word dubbed the ‘Othello syndrome’, with reference to jealous as ‘feeling or showing resentment towards the irrational jealousy of Shakespeare’s Othello a person one thinks of as a rival’. This definition (Todd & Dewhurst, 1955). This is misleading, as it indicates that it is the belief in the presence of rivalry suggests that morbid jealousy is a unitary syndrome. that is the key issue, and that whether or not such a Demonstrably, this is not the case, and morbid rivalry truly exists is less important. Jealousy within jealousy should be considered to be a descriptive a sexual relationship has clear advantages in term for the result of a number of psychopathologies evolutionary terms: behaviour that ensures the within separate psychiatric diagnoses (Shepherd, absolute sole possession of a partner allows the 1961). propagation of one’s own genes at the expense of those of a true rival (Daly et al, 1982). However, when the belief in rivalry is mistaken, much time and effort Epidemiology may be wasted in attempting to eliminate a false threat. The prevalence of morbid jealousy is unknown, as Morbid jealousy describes a range of irrational no community survey exists. It has been regarded thoughts and emotions, together with associated as a rare entity (Enoch & Trethowan, 1979), but most unacceptable or extreme behaviour, in which the practising clinicians encounter it not uncommonly. dominant theme is a preoccupation with a partner’s They may miss cases that present with other sexual unfaithfulness based on unfounded evidence dominating psychopathologies and will never see (Cobb, 1979). It is noteworthy that individuals may those cases that do not result in psychiatric referral. suffer from morbid jealousy even when their partner In a sample of 20 cases of delusional jealousy is being unfaithful, provided that the evidence that studied in California, Silva et al (1998) found that they cite for unfaithfulness is incorrect and the the average age at onset of was 28 years response to such evidence on the part of the accuser and that delusional jealousy began an average of 10 is excessive or irrational. Healthy people become years later. The oldest patient was 77 years of age. jealous only in response to firm evidence, are Of the 20 individuals, 19 were male. Eighty per cent prepared to modify their beliefs and reactions as of the sample were married and living with their new information becomes available, and perceive a spouses. The ethnicity of the sample reflected the single rival. In contrast, morbidly jealous indi- ethnicity of the population, so that no correlation viduals interpret conclusive evidence of infidelity between ethnicity and delusional jealousy was from irrelevant occurrences, refuse to change their observed. beliefs even in the face of conflicting information, Statistics on geographical prevalence and and tend to accuse the partner of infidelity with ethnicity are not available, although scientific many others (Vauhkonen, 1968). papers dealing with morbid jealousy have been

Michael Kingham is currently a locum consultant forensic psychiatrist at the Trevor Gibbens Unit in Kent (Trevor Gibbens Unit, Hermitage Lane, Maidstone, Kent ME16 9QQ, UK), having recently worked as a specialist registrar at Broadmoor Hospital. Harvey Gordon is a consultant forensic psychiatrist for the South London and Maudsley NHS Trust and an honorary lecturer in forensic psychiatry at the Institute of Psychiatry, London. He has also worked at Broadmoor Hospital.

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published by European, North American and Box 1 Characteristics of in morbid Australasian authors. Bhugra (1993) suggests that jealousy there are societies less prone to jealousy because they place no value on the exclusive ownership of a partner. Delusions are: • the individual’s own thought Psychopathology and diagnosis • egosyntonic • regarded as true Mullen (1990) considered morbid jealousy to be • not resisted associated with four features: first, that an under- lying emerges before or with the jealousy; second, that the features of the underlying present actions are misinterpreted to produce an disorder coexist with the jealousy; third, that the absolute conviction of repeated betrayal (Mullen, course of morbid jealousy closely relates to that of 1991). the underlying disorder; and fourth, that the Affective disorders complete the functional jealousy has no basis in reality. However, it can also illnesses associated with delusions of infidelity. be argued that delusions of infidelity can still be Depression, with accompanying subjective feelings pathological, even where a partner is unfaithful, of inadequacy and failure, may give rise to because there is no logical evidence being adduced delusional jealousy or it may follow its onset. It may for the beliefs. be difficult to decide whether depression is primary In morbid jealousy, the content of the psycho- or secondary (Cobb & Marks, 1979). In one study of pathological experience is the preoccupation with morbid jealousy, depression was present in more a partner’s sexual infidelity. The most commonly than half of the patients (Mullen & Maack, 1985). cited forms of psychopathology in morbid jealousy Organic brain disorders may give rise to delusions are delusions, obsessions and overvalued ideas. of infidelity. In their series, Mullen & Maack (1985) found that almost 15% of individuals with morbid jealousy had an organic psychosyndrome with Delusions which the jealousy appeared associated. Cobb (1979) Some authors equate morbid jealousy with a recorded that morbid jealousy may be present with delusional state (e.g. Enoch & Trethowan, 1979) all types of cerebral insult or injury. (Box 1). Shepherd (1961) pointed out that the commonly used term ‘ of jealousy’ is a mis- Obsessions nomer and that the key psychopathology is a delusion of (the partner’s) infidelity. Associated In obsessional jealousy, jealous thoughts are beliefs may include the morbidly jealous subject’s experienced as intrusive and excessive, and suspicion that he or she is being poisoned or given compulsive behaviours such as checking may substances to decrease sexual potency by the partner, follow. Such patients recognise that their fears are or that the partner has contracted a sexually without foundation and are ashamed of them transmitted disease from a third party, or is engaging (Box 2) (Shepherd, 1961; Mooney, 1965; Cobb & in sexual intercourse with a third party while the Marks, 1979, Bishay et al, 1989; Stein et al, 1994). subject sleeps. These are persecutory delusions, and Egodystonicity (the distress caused by thoughts that the delusion of infidelity itself may be viewed are unwanted and viewed as contrary to conscious similarly. wishes) characteristically varies considerably Delusions of infidelity may be the initial presen- between patients, and a continuum from obsessional tation of , or appear as new features to delusional morbid jealousy has therefore been within an established psychosis. Delusional suggested (Insel & Akiskal, 1986). jealousy is a subtype of delusional disorder as described by DSM–IV (American Psychiatric Association, 1994) and ICD–10 (World Health Box 2 Characteristics of obsessions in morbid Organization, 1992). In these cases, delusions of jealousy infidelity exist without any other psychopathology and may be considered to be morbid jealousy in Obsessions are: its ‘purest’ form. The delusions are expressed • the individual’s own thought coherently and are elaborated thoughtfully and • egodystonic plausibly, in contrast to the bizarre associations • acknowledged to be senseless characteristically made in schizophrenia. Memories • usually resisted are revised and reinterpreted and the partner’s

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idea is underestimated and really represents a Box 3 Distinguishing normal from obsessional delusion. jealousy (Marazziti et al, 2003) Borderline personality organisation (Dutton, The following are more extreme in obsessional 1994) is an important potential predisposing jealousy: condition in any form of morbid jealousy (Box 5). It may be especially so in individuals with a paranoid • time taken up by jealous concerns personality, which gives rise to overvalued ideas of • difficulty in putting the concerns out of the infidelity. mind • impairment of the relationship • limitation of the partner’s freedom Comorbidity • checking on the partner’s behaviour Comorbidity is usual in morbid jealousy, and the ‘pure’ forms are rare. The presence of various combinations of comorbidity with personality In a study of young adults, Marazziti et al (2003) disorder, mental illness and substance misuse can identified a number of factors that, when taken to produce a very complicated picture. For example, a the extreme, distinguish normal from obsessional person with a paranoid personality disorder may jealousy (Box 3). become preoccupied with and distressed by jealous Mullen (1990) considered an obsessional disorder overvalued ideas, develop a delusion of infidelity at the core of morbid jealousy to be a ‘true rarity’. and turn to substance misuse in an attempt at self- Cobb (1979) concluded that, although a distinction medication. was occasionally difficult to make, the categories of ‘psychotic’ (delusional) and ‘neurotic’ jealousy contained similar proportions (each between one- Theories of development third and one-half). Psychodynamic Overvalued ideas Freud considered that delusional jealousy repre- sented projected latent homosexuality, in terms of Sims (1995: pp. 17 & 368) raised the possibility that ‘I do not love him for she loves him’ (Freud, 1922). morbid jealousy could take the form of an ‘over- Klein highlighted the rivalry between son (the valued idea’ (Box 4), that is, an acceptable, jealous individual) and father (the supposed rival) comprehensible idea pursued by the patient beyond in the Oedipus complex (Klein, quoted in Shepherd, the bounds of reason. The idea is not resisted and, 1961). Seeman (1979) suggested that the role of although it is not a delusion, the patient character- competitiveness is significant, along with projective istically attaches utmost importance to investigating mechanisms and identification with the rival. and maintaining the partner’s fidelity at great Attachment theory has been advanced to explain personal disadvantage and to the distress of the male jealousy, anger and assaults against the female partner. partner within intimate relationships (Dutton et al, Overvalued ideas of morbid jealousy are described 1994; Box 5). Insecurely attached individuals, in the paranoid personality disorders classification of DSM–IV and ICD–10. The prevalence of this subtype of morbid jealousy is unknown, and it is likely that a substantial Box 5 Characteristics of individuals with proportion of people with these traits never present borderline personality organisation (after to mental health services. It is probable that in some Dutton et al, 1994) recognised cases, what is identified as an overvalued • Negative self-model • Feelings of unworthiness • Identity diffusion (poorly integrated sense of Box 4 Characteristics of overvalued ideas in self and of significant others) morbid jealousy • Anxiety about rejection and abandonment in close relationships Overvalued ideas are: • Perception of unfaithfulness in partner • the individual’s own thought • Affective instability, including anger within • egosyntonic the intimate relationship and jealousy • amenable to reason • Primitive defence mechanisms, especially • not resisted projection of unacceptable impulses

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especially those of the fearful and preoccupied type, In highly conservative cultures, any evidence of may be at increased risk of becoming anxious about autonomous or independent activity by a partner their partner’s attachment to them. Insecure attach- may be interpreted as evidence of infidelity and ment style correlates strongly with borderline punished. Jealousy in this context may be used to personality organisation. justify violence towards a partner who is perceived as unfaithful. For these reasons, it is important to be sceptical Cognitive about claims by patients who are violent towards their partners in the context of jealousy that their Enoch & Trethowan (1979) viewed a sense of victims (usually female) have provoked or actively inadequacy, oversensitivity and insecurity to be encouraged them to be jealous. major predisposing factors in the development of The possibility of significant mental disorder in morbid jealousy. In their cognitive formulation, the patient’s partner should be considered. In one Tarrier et al (1990) proposed that people with these instance, as a husband’s delusional jealousy was characteristics tend to make systematic distortions successfully treated, the wife developed a paranoid and errors in their perceptions and interpretation of psychosis, which receded as the husband’s jealousy events and information, so that a precipitating event returned (Turbott, 1981). Abnormal jealousy in gives rise to faulty assumptions and provokes homosexual patients has also been described morbid jealousy. These ideas resemble those (Gordon et al, 1997). Economic depression has been described by attachment theory, especially in the associated with increased incidence of delusional context of borderline or paranoid personality jealousy (Shepherd, 1961). organisation. Docherty & Ellis (1976) documented three morbidly jealous men, each of whom, during Associated alcohol and drug use adolescence, saw his mother engaged in extra- marital sexual activity. Although the authors Alcohol misuse has a well-recognised association interpreted the morbid jealousy of these men in with morbid jealousy (Shepherd, 1961). In two psychodynamic terms (relating to Oedipal issues), studies, morbid jealousy was present in 27% and their suggestion for therapy to combat cognitive 34% respectively of men recruited from alcohol distortion is in line with cognitive–behavioural treatment services (Shrestha et al, 1985; Michael therapy. et al, 1995). Given the prevalence of harmful and dependent use of alcohol in the UK, these figures suggest that morbid jealousy is not rare. Some authors consider alcohol to exacerbate It has also been suggested that morbid jealousy may existing morbid jealousy, but rarely to be a primary arise in response to reduced sexual function. Cobb cause (Langfeldt, 1961; Shepherd, 1961; Cobb, 1979). (1979) drew attention to the elderly man whose This is disputed by Michael et al (1995), who waning sexual powers are insufficient to satisfy a described 65 of 71 male subjects as developing younger wife. Vauhkonen (1968) described sexual morbid jealousy following, and presumably dysfunction per se to be important, but whether this secondary to, alcohol dependence. was considered to be primary or secondary is Amphetamine and cocaine use can give rise unclear. Todd et al (1971) reported that real or to delusions of infidelity that may persist after imaginary hypophallism may give rise to feelings intoxication ceases (Shepherd, 1961). One case of inferiority and lead to the development of morbid report described a man prescribed dexamphetamine jealousy. for adult attention-deficit hyperactivity disorder who developed morbid jealousy (Pillai & Kraya, Marital and social factors 2000). A likely explanation for morbid jealousy that is In cultures in which partners are treated as present apparently only at times of intoxication is possessions, jealousy is often considered to be a that it exists at other times but in an inhibited state. normal part of sexual relationships and it may The disinhibition that accompanies intoxication therefore be seen as an understandable (although results in its manifestation. The individual who undesirable) explanation for marital tension. turns to substance use may be attempting to cope Gender-role behaviour in which the male partner is with the symptoms of either borderline or paranoid dominant and the female submissive, in which there personality organisation, with accompanying is a sense of sexual ownership, is generally tolerated. jealousy.

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Risks associated with morbid victim had been the partner. In Mooney’s (1965) series, 14% of morbidly jealous individuals were jealousy considered to have made ‘homicidal attempts’, the Confirmatory behaviours majority against the accused partner. Repeated denials of infidelity may provoke Once suspicions regarding the partner’s fidelity are extreme anger and violence. Alternatively, the long- established, they quickly become preoccupying. suffering partner, plagued by repeated cross- Overt behaviours to investigate suspicions and examination and accusations of infidelity, may yield preoccupations are common and evident to all and give a false confession, provoking a violent rage involved. They include interrogation of the partner, in the jealous individual. repeated telephone calls to work and surprise visits, Domestic violence is a common result of jealousy, behaviour, or hiring a private detective to normal or morbid. According to the British Crime follow the partner. Jealous individuals may search Survey, 23% of women and 15% of men have been the partner’s clothes and possessions, scrutinise physically assaulted by their partners (Mirrlees- diaries and correspondence, and examine bed linen, Black, 1999). Domestic violence is associated with underclothes and even genitalia for evidence of increased risk of death at the hands of the perpe- sexual activity. They may hide recording equipment trator. It is also associated with morbid jealousy in to detect clandestine liaisons, and some go to the context of borderline personality organisation extreme lengths, including violence, to extract a in males (Dutton, 1994). confession from their partner. Mullen & Maack (1985) found in their UK series The accused partner is assumed to be guilty until that more than half of morbidly jealous individuals evidence of innocence is found, but this cannot physically assaulted their partner, although none materialise. Heroic efforts to prove innocence or had come to the attention of the criminal justice disprove guilt must fail, as irrational preoccupations system. Morbidly jealous men were more likely to cannot be refuted rationally (Shepherd, 1961; attack their partners than were morbidly jealous Mooney, 1965; Seeman, 1979). women and they tended to inflict more serious injuries. In their US sample of 20 individuals with Harm to self delusional jealousy, 19 of whom were male, Silva et al (1998) found that 13 had threatened to kill their Suicidal ideation is not uncommon in morbid spouse because of alleged infidelity – of these, 9 had jealousy, given the association with depression and actually attacked their spouse. Overall, 12 had substance misuse. Aggressive challenging of the harmed their spouse, 3 of them using a weapon. partner may be followed by intense remorse during The presence of paranoid delusions and command which suicidal action may occur (Shepherd, 1961). hallucinations to injure the spouse were associated In a UK population, Mooney (1965) found that 20% with violence, suggesting that individuals with of morbidly jealous individuals had made delusional jealousy who perpetrate violence may attempts. Where jealousy gives rise to fatal violence be driven directly by psychotic phenomena. Alcohol against the partner, this may be followed by suicide consumption was also associated with a higher risk (West, 1965). of assault. Accusations may be made and violence directed Risk to others towards a third party believed to be the partner’s lover, the ‘paramour’ (Tarrier et al, 1990). Seven out Violence may occur in any relationship marred by of 110 victims of homicide or serious assault were jealousy, although the risk may be greater in morbid supposed paramours in Mowat’s study (1966). jealousy (Mullen, 1990). Culturally, jealousy may be More than 50% of the alleged paramours in Silva used to justify violence towards partners, and in et al’s (1998) study of delusional jealousy were some courts of law it can even be used as the basis known to the subject. However, no serious threats of of a provocation defence. Victims of homicide are harm or incidents of violence were made against most likely to be current or ex-partners; this is true them. for both male and female perpetrators. The gender difference in physical assault against Dell (1984) concluded that ‘amorous jealousy/ partners found by Mullen & Maack (1985) is difficult possessiveness’ accounted for 17% of all cases of to quantify because violence by women against men homicide in the UK. Mowat (1966) reported on 110 may be underreported. Similarly, given the problems morbidly jealous subjects who had killed or in distinguishing accurately between delusions, committed serious assaults and been admitted to a obsessions and overvalued ideas, it is difficult to British forensic psychiatric facility. In 94 cases, the estimate the relative risk of interpersonal violence

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of each form. Nevertheless, psychotic drive in delusional jealousy seems to be a particularly Box 6 Assessment of morbid jealousy important association, as it is generally in linking Take a full psychiatric history, including: psychotic conditions and violent actions. Overall, • affective and psychotic disorders morbid jealousy indicates a paranoid state of mind • threatened and perpetrated violence and therefore is likely to be associated with a high • the quality of the relationship risk of violence. • family constitution • substance misuse Risk to children • collateral and separate history from spouse Carry out a mental state examination, including: Children in the household may suffer emotional and • the form of morbid jealousy physical abuse as a result of the actions of a morbidly • associated psychopathology jealous parent. They may witness arguments and • consideration of organic disorder physical violence between their parents or be injured accidentally during assaults. They may be employed Conduct a risk assessment for both partners, by the morbidly jealous partner to spy on a parent. considering: They may even see a homicide or suicide in which a • suicide parent is the victim. • history of domestic violence • history of interpersonal violence, including any third party (e.g. suspected rival) Other risks • risk to children Partners of morbidly jealous people may develop mental disorder, including anxiety and depression, or may turn to substance misuse (Tarrier et al, 1990). Regarding risk, the issue of suicidal ideation Vauhkonen (1968) described two cases in which should be raised with both partners. Enquiries jealousy became apparent only after the partner had about confrontations, arguments, threats and actual made suicide attempts in response to persistent violence perpetrated by the jealous individual unreasonable accusations. Rarely, partners may should be made, so that the risk of interpersonal respond violently themselves to repeated con- violence, especially to the partner and any third frontations. Severe psychological damage to party identified as a rival, can be assessed. The risk individuals, couples and families arising from to children in the household should be considered, morbid jealousy is discussed by Cobb (1979). and protecting them is a paramount concern.

Management of morbid jealousy Initial considerations Assessment following assessment

Assessment of morbid jealousy requires a wide- It is wise to share information about risk with both ranging approach (Box 6). Careful history-taking partners. Consent should first be sought from the should be employed, and, if possible, both partners patient, unless the risk to another individual is should be interviewed separately and together. The serious and immediate, in which case confi- issue of jealousy should be approached tactfully, as dentiality may be broken. All necessary steps should the jealous individual may believe that the partner’s be taken to protect a potential victim: this may range alleged infidelity is creating the difficulties, not their from giving advice to that person to notifying the own jealousy. It is important to complete a full police. If there is a high risk of harm, the morbidly psychiatric history and mental state examination, jealous individual should be admitted to hospital looking carefully at the phenomenology of the immediately. Child protection proceedings should jealousy. It may be possible to distinguish between be instituted if necessary. jealousy that is delusional, obsessional or an over- If there is a history of violence, it should be made valued idea, and this may be significant in terms of clear that physical abuse is unacceptable and illegal. risk. Evidence of associated mental illness and Criminal and civil law (the Family Law Act 1996) substance misuse should be carefully elicited. It is provide protection against domestic violence, and recommended that more than one interview be victims may be advised to seek legal advice. Child conducted to assess the marital relationship, and protection proceedings should be initiated in accord- that a sexual and domestic violence history be taken ance with the Children Act 1989 if there is cause to from both partners, who should be seen separately suspect that a child is suffering, or is likely to suffer, as well as together. significant harm (Department of Health, 1999).

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If morbid jealousy is refractory to treatment, Box 7 Management of morbid jealousy geographical separation of the partners may be all Principles of management: that is effective (Shepherd, 1961). In-patient • Treat the mental disorder admission may bring about temporary cessation of • Manage the risk morbid jealousy through separation, but – all other things being equal – it is likely to return when Biological options: normal arrangements resume. With the assistance • Antipsychotic medication of a social worker, the victim may be advised to • Selective serotonin reuptake inhibitors approach the local authority under the Housing Act Psychosocial options: 1996, in which individuals who suffer domestic • Treatment of any substance misuse violence are designated as homeless. Emergency • Cognitive–behavioural therapy accommodation is prioritised for women who are • Couple therapy pregnant, have dependent children or are deemed • Dynamic psychotherapy to be vulnerable. • Child protection proceedings After separation, the morbidly jealous partner may • Admission to hospital (compulsory detention continue to intrude upon and even stalk the victim, if necessary) maintaining a sense of entitlement to the partner, • Geographical separation of the partners seeking a reconciliation and expecting continuing fidelity. Among stalkers, those who have had a prior relationship with the victim may be most likely to act violently against them (Mullen et al, 2000). Treatment Legislation such as the Protection from Harassment Act 1997 can provide protection and should be A range of biological and psychosocial options are recommended to those who suffer in this way (Royal available for the management of morbid jealousy. College of Psychiatrists, 2002). These include medication, psychotherapy and hospital admission (Box 7). Prognosis Medication Generally, the prognosis for morbid jealousy depends When occurring alone, as in a delusional disorder on the underlying phenomenology, the existence of or in the context of schizophrenia, delusions of comorbid mental disorders and the response to infidelity may respond to antipsychotic medication therapy. Langfeldt (1961) and Mooney (1965) (Mooney, 1965; Byrne & Yatham, 1989). Obsessional considered a third of their patients to have made jealousy, whether part of a depressive illness or not, significant improvement, but that those with may respond to selective serotonin reuptake psychotic disorders had a poorer prognosis. The inhibitors (Lane, 1990; Gross, 1991; Stein et al, 1994). possibility that morbid jealousy will recur is significant, and careful monitoring is warranted Psychosocial interventions indefinitely. Scott (1977) reported a number of second Cognitive therapy is effective in morbid jealousy, homicides due to morbid jealousy following mainly when obsessions are prominent (Cobb & discharge from prison or release from special Marks, 1979; Bishay et al, 1989; Dolan & Bishay, hospital after years of apparent well-being. It is not 1996). Also endorsed are couple therapy (Cobb, 1979) clear what treatment was provided for these and individual dynamic psychotherapy (Seeman, individuals. 1979). Dynamic psychotherapy has a place in the treatment of morbidly jealous individuals in whom personality disorders with borderline and paranoid Conclusions traits are present. Substance misuse should be addressed where Morbid jealousy is a symptom rather than a necessary, using standard accepted methods such diagnosis. It may take the form of a delusion, an as motivational interviewing. obsession or an overvalued idea, or combinations of these. The nature of its form, and other features Admission to hospital evident from the history and mental state examin- ation, should reveal the underlying diagnosis – or When morbid jealousy gives rise to appreciable diagnoses – and allow appropriate management. distress, a significant risk of harm or is not managed Undoubtedly, alcohol misuse is an important satisfactorily by out-patient treatment, admission to association, and any substance misuse should be hospital may be necessary. treated as a priority.

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Morbid jealousy has the potential to cause Langfeldt, G. (1961) The erotic jealousy syndrome: a clinical study. Acta Psychiatrica Scandinavica, 36 (suppl. 151), 7– enormous distress to both partners within a relation- 68. ship and to their family. It carries with it a risk of Marazziti, D., Di Nasso, E., Masala, I., et al (2003) Normal serious violence and suicide. Clearly, early identi- and obsessional jealousy: a study of a population of young adults. European Psychiatry, 18, 106–111. fication and treatment are most important to prevent Michael, A., Mirza, S., Mirza, K. A. H., et al (1995) Morbid serious harm, and vigilance should be maintained. jealousy in . British Journal of Psychiatry, 167, Risk management includes hospital admission of 668–672. Mirrlees-Black, C. (1999) Findings from a New British Crime morbidly jealous individuals where necessary, Survey Self-completion Questionnaire. London: Stationery together with taking steps to protect potential Office. victims. 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Multiple choice questions d it is otherwise known as Fregoli’s syndrome e homicide perpetrated in morbid jealousy is usually 1 Morbid jealousy: committed against the suspected rival. a is found in ICD–10 as a diagnostic classification b is a symptom of a mental disorder 4 Morbid jealousy: c is a disorder of content rather than of form a never affects women d may take different psychopathological forms b is a contraindication to admission to a general e is a paraphilia. psychiatric ward c is too rare to be of concern to general adult 2 Morbid jealousy is a disorder of content, in which psychiatrists the form may be: d may be associated with significant interpersonal a a delusion violence b an obsession e requires proof that the spouse is faithful to be a valid c a combination of a delusion and an obsession symptom. d an illusion e an overvalued idea. 5 Recognised associations of morbid jealousy include: a amphetamine use 3 Regarding morbid jealousy: b an organic brain syndrome a it is found exclusively in the northern hemisphere c alcohol use b it may be said to have afflicted Shakespeare’s Othello d schizophrenia c it is otherwise known as de Clerambault’s syndrome e low self-esteem.

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MCQ answers 12345 aF aT aF aF aT bT bT bT bF bT cT cT cF cF cT dT dF dF dT dT eF eT eF eF eT

Advances in Psychiatric Treatment (2004), vol. 10. http://apt.rcpsych.org/ 215